Association of Video Gaming With Cognitive Performance Among Children
Authors: Bader Chaarani, Joseph Ortigara, DeKang Yuan, Hannah Loso, Alexandra Potter, Hugh P. Garavan
Journal: JAMA Network Open (2022)

Importance Although most research has linked video gaming to subsequent increases in aggressive behavior in children after accounting for prior aggression, findings have been divided with respect to video gaming’s association with cognitive skills. Objective To examine the association between video gaming and cognitive performance in children using data from the Adolescent Brain Cognitive Development (ABCD) study. Design, Setting, and Participants In this cross-sectional study, cognitive performance and blood oxygen level–dependent (BOLD) signal were compared in video gamers (VGs) and non–video gamers (NVGs) during response inhibition and working memory using task-based functional magnetic resonance imaging (fMRI) in a large data set of 9- and 10-year-old children from the ABCD study. A sample from the baseline assessment of the ABCD 2.0.1 release in 2019 was largely recruited across 21 sites in the US through public, private, and charter elementary schools using a population neuroscience approach aiming to mirror demographic variation in the US population. Children with valid neuroimaging and behavioral data were included, with adjustments performed for demographic, behavioral, and psychiatric confounding factors. Some exclusions included common MRI contraindications, history of major neurologic disorders, and history of traumatic brain injury. Collected data were analyzed between October 2019 and October 2020, with additional analyses in 2023. Exposures Participants completed a self-reported screen time survey, including an item asking children to report the time specifically spent on video gaming. All fMRI tasks were performed by all participants. Main Outcomes and Measures Cognitive performance, assessed with stop signal tasks (SST) and n-back tasks; and BOLD signal on fMRI during the tasks. Mental health symptoms were evaluated using the Child Behavior Checklist and included raw scores of behavioral (anxiety, depression, somatic, social, attention, rule breaking, and aggression concerns) and psychiatric categories ( Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , diagnoses of depression, anxiety, somaticism, attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct disorder). Results A total of 2217 children (mean [SD] age, 119 [7.6] months; 9.91 [0.62] years; 1399 [63.1%] female) participated in this study. The final sample used in the stop signal task analyses consisted of 1128 NVGs (0 gaming hours per week) and 679 VGs who played at least 21 hours per week. The final sample used in the n-back analyses consisted of 1278 NVGs who had never played video games (0 hours per week of gaming) and 800 VGs who played at least 21 hours per week. The NVG vs VG groups did not differ on age but did differ on sex, race and ethnicity, combined parental income, body mass index, and IQ. There were no differences in body mass index and IQ after adjusting for sociodemographic variables. The Child Behavior Checklist behavioral and mental health scores were higher in VGs, with attention problems, depression, and attention-deficit/hyperactivity disorder scores significantly higher in the VGs compared with the NVGs. The VGs performed better on both fMRI tasks compared with the NVGs; the differences were statistically significant but very small. VGs had significantly faster stop signal reaction times compared with NVGs (adjusted means [SE]; 287.3 [9.8] vs 300.1 [9.6], standardized mean difference [SMD] 0.04 milliseconds; P = .018) and correct go reaction times (adjusted means [SE], 514 [2.9] vs 552 [2.2] milliseconds; SMD 0.05; P = .002). Following a similar pattern, 0-back D' measures of the n-back task were significantly higher in VGs compared with NVGs (adjusted means [SE], 2.33 [0.03] vs 2.18 [0.03]; SMD, 0.15; P &amp;amp;lt; .001). Similarly, adjusted means (SE) 2-back D′ scores were significantly higher in VGs relative to NVGs (1.87 [0.03] vs 1.72 [0.02]; SMD 0.15; P &amp;amp;lt; .002), and reaction times for correct responses during the 2-back conditions were faster in VGs relative to NVGs (adjusted means [SE]; 1025 [4.8] vs 1069 [3.7] milliseconds; P &amp;amp;lt; .002). Nonparametric analyses of fMRI data demonstrated a greater BOLD signal in VGs in the precuneus during inhibitory control. During working memory, a smaller BOLD signal was observed in VGs in parts of the occipital cortex and calcarine sulcus and a larger BOLD signal in the cingulate, middle, and frontal gyri and the precuneus. Conclusions and Relevance In this study, compared with NVGs, VGs were found to exhibit faster reaction times in measures of cognitive performance involving response inhibition and working memory and differences in fMRI BOLD signals in key regions of the cortex responsible for visual, attention, and memory processing. The very small differences in reaction times lack clinical relevance but were consistent with a potential association between videogaming and cognitive performance that involve response inhibition and working memory and the underlying cortical pathways. Concerns about the association with mental health symptoms may warrant further study.